The 18 states of Alabama, California, Colorado, Connecticut, Florida, Illinois, Maine, Massachusetts, Maryland, New Hampshire, New Jersey, Nevada, New York, Oregon, Pennsylvania, Vermont, Virginia, and Wisconsinall have medical exemption clauses in their rabies laws, with Pennsylvania’s Governor Corbett having just signed one into law on July 9, 2013.

Labels on rabies vaccines declare that they are for “the vaccination of healthycats, [and] dogs,” because vaccinating an unhealthy animal may not produce the desired immunologic response. As Pfizer’s rabies vaccine labels warn: " A protective immune response may not be elicited if animals are incubating an infectious disease are malnourished or parasitized are stressed due to shipment or environmental conditions are otherwise immunocompromised…." Passage of a medical exemption clause would allow Iowa’s veterinarians to write waivers for animals whose lives would be jeopardized by or whose medical conditions would be exacerbated by vaccination, including those with past anaphylactic reactions to the rabies vaccine or those suffering from cancer, kidney/liver failure, hemolytic anemia, thrombocytopenia, lymphoma, grand mal seizures, and chronic autoimmune disorders.

The American Animal Hospital Association advises veterinarians "...to avoid administration of any vaccine to patients with a history of systemic disease suspected to be associated with previous vaccination (e.g., immune-mediated hemolytic anemia, immune-mediated thrombocytopenia) or known to be caused by vaccine (vaccination-site cutaneous ischemic vasculitis after administration of rabies vaccine).”(1) They further recommend that “[d]ogs receiving immunosuppressive chemotherapy should not be vaccinated.” (2)

The State of Maine inserted the following medical exemption into their rabies protocol, Title 7 M.R.S.A., Sec. 3922(3), in April 2005:

“5 A. A letter of exemption from vaccination may be submitted for licensure, if a medical reason exists that precludes the vaccination of the dog. Qualifying letters must be in the form of a written statement, signed by a licensed veterinarian, that includes a description of the dog, and the medical reason that precludes vaccination. If the medical reason is temporary, the letter shall indicate a time of expiration of the exemption.

B. A dog exempted under the provisions of paragraph 5 A, above, shall be considered unvaccinated, for the purposes of 10-144 C.M.R. Ch.251, Section 7(B)(1), (Rules Governing Rabies Management) in the case of said dog's exposure to a confirmed or suspect rabid animal.”

Without a provision for medical waivers in Iowa Code Title 9, Subtitle 1 Chapter 351 Section 351.33, Iowa’s rabies immunization requirement poses an ethical dilemma for veterinarians with seriously ill patients -- they must either violate their Veterinarian’s Oath and administer a rabies vaccine conflicting with sound medical practice and contrary to manufacturer’s labeled instructions, or recommend that clients break the law by not immunizing their unhealthy pets. Additionally, veterinarians face potential liability for any adverse reactions suffered after administering a vaccine inconsistent with labeled directions when immunizing sick animals against rabies. Owners may choose not to comply with the law rather than risk their pets’ lives and subsequently fail to license them to avoid detection.

On behalf of The Rabies Challenge Fund Charitable Trust, veterinarian Franchesca Zenitsky, and other Iowa pet owners who have contacted us for assistance, we urge you to introduce legislation to insert a medical exemption clause into Chapter 351 Section 351.33 of the Iowa Code. Please contact me if you would like any scientific data on the rabies vaccine or have any questions.

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